Forms and Resources

Click on your state to view

Forms

Employer's First Report of Injury
Alabama State Specific Forms
Drugfree Workplace

Resources

Department of Labor – Workers' Comp - labor.alabama.gov
Independent Agents of AL - www.aiia.org

Forms

DFS-F2-DWC-1 First Report of Injury or Illness
09-1 Drug Free Application
09-3 Safety Credit Form
09-4 FCCPAP Form (Florida Contracting Classification Premium Adjustment Program)

Resources

Florida Association of Insurance Agents (FAIA) - www.faia.com
Latin American Association of Insurance Agencies - www.laaia.com
Home Page for the Florida Division of Workers' Compensation Website - www.myfloridacfo.com
Division of Workers' Compensation Databases - dwcdataportal.fldfs.com
This link has a number of useful state databases, such as Proof of Coverage and WC Policy Search

Forms

First Report of Injury or Illness
Louisiana State Specific Forms

Resources

LA Workers’ Comp Commission - www.laworks.net
Independent Agent of LA - www.iiabl.com

Forms

First Report of Injury or Illness
Mississippi State Specific Forms

Resources

MS Workers' Comp Commission - mwcc.ms.gov
Independent Agent of MS - www.msagent.org

Forms

Report of Injury
North Missouri Specific Forms
Loss Cost Filings

Resources

MO Dept of Insurance - insurance.mo.gov
Trusted Choice Independent Agents - www.trustedchoice.com
MO Association of Insurance Agents - www.moagent.org

Forms

First Report of Injury or Illness
North Jersey State Specific Forms

Resources

NJ Compensation Rating & Inspection Bureau/NJCRIB - www.njcrib.com
NJ coverage search - www.njcrib.com
NJ Independent Agents - www.biginj.org

Forms

First Notice of Claim For Compensation
Oklahoma State Specific Forms

Resources

OK Workers’ Comp Commission - www.ok.gov
Independent Agent of OK - www.iiaok.com

Forms

LIBC-90 First Report of Injury
LIBC-500 Remember: It is Important to tell Your Employer About your Injury

Resources

Experience Modifications - www.dcrb.com
Coverage verification and Bureau code search - www.dli.pa.gov
Independent Agents of PA, MD, and DE - www.iabforme.com

Forms

Employer's First Report of Injury or Illness
Tennessee State Specific Forms

Resources

TN Department of Insurance - www.tn.gov
Professional Insurance Agents of TN - piatn.com

Forms

First Report of Work Injury or Illness
Texas State Specific Forms

Resources

TX Dept of Insurance - www.tdi.texas.gov
Agent appointments - www.tdi.texas.gov
Coverage verification through TX Comp - www.tdi.texas.gov
Independent Agents of TX - www.iiat.org

Forms

First Report of Injury
16A Rejection of Coverage
Address Change

Resources

Professional Insurance Agents Association - Virginia and DC - www.piavadc.com
VA Workers' Compensation Commission - vwc.state.va.us

Get in Touch

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Email: info@normandyins.com

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